Provider Demographics
NPI:1992324784
Name:IBIROGBA, ENIOLA RAHEEM (MBBS)
Entity type:Individual
Prefix:
First Name:ENIOLA
Middle Name:RAHEEM
Last Name:IBIROGBA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 BARCLAY AVE NE STE 304
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2527
Mailing Address - Country:US
Mailing Address - Phone:616-391-2160
Mailing Address - Fax:616-391-2683
Practice Address - Street 1:330 BARCLAY AVE NE STE 304
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2527
Practice Address - Country:US
Practice Address - Phone:616-391-2160
Practice Address - Fax:616-391-2683
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351047274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology